According to the MarkeTrak VII survey (Kochkin 2008), there are roughly 35 million individuals in the US with some degree of hearing loss. Of these, almost 10 million have hearing aids and 67,000 have cochlear implants. The goal of auditory (re)habilitation (AR) programs is to build the listening skills of individuals with hearing loss, so that they can comprehend the language in their environment. With appropriate hearing devices and AR, individuals with hearing loss can begin to discriminate and identify the speech sounds in the spoken language around them. In Phase I of this project we developed an adaptive computer-guided AR software program called the Sound Identification Tutor (SIT) that focused on sound identification and discrimination. For a video demonstration showcasing the SIT please visit http://www.biospeech.com/research/ar.html. The SIT provides an automated sequence of sound targets to be trained and it chooses the type of target depending on the performance of the user. It also chooses whether to present the target in auditory or audiovisual mode. The SIT uses natural human audiovisual recordings of all the word targets. It also uses child-friendly images of simple words to make this software suitable and fun for children. The results of an evaluation of the software with 24 children and adults showed that over a course of 10 sessions subjects significantly improved their sound identification skills. Children benefitted more from the automated lesson sequence than adults. Adults tended to prefer to choose their own sound targets to train on. In addition, we showed that subjects improved on specific sound targets they trained on, but problematic targets from the pre-test that were not trained on did not improve in the post-test. This showcases the fact that improvements were not caused by increased exposure to speech but by training specific sound targets. In this Phase II proposal, we will extend the SIT and develop it into a marketable product. The proposal consists of the following aims: (i) To Build a Spanish Version of the SIT; (ii) To Extend the SIT with Words Embedded in Sentences with Optional Background Noise and Multiple Speakers; (iii) To Extend the Open- Ended Training Module of the SIT; (iv) To Expand the SIT to Create a DVD installer, Interface with the Web, and Develop an In-home Login UI; (v) To Evaluate the Program Specifically for In-home Use; (vi) To Create a Built-in Assessment Protocol to Produce User-specific Listening Intervention Plans PUBLIC HEALTH RELEVANCE: In the United States, there are roughly 35 million individuals with some degree of hearing loss and of these, almost 10 million have hearing aids and 67,000 have cochlear implants who need intensive auditory (re)habilitation (AR) training to fully realize the potential benefit of their prostheses and attain intelligible speech. Face-to-face AR training with a specialist is expensive, not always covered by insurance and not always feasible because clients may not have access to a specialist, esp. if they speak a different language. The proposed project will expand upon an adaptive computer-guided software program (the Speech Identification Tutor, SIT) that focuses on learning phoneme discrimination and identification and will provide a Spanish version of the software, provide additional synthetic voices for open-ended training, provide an additional adaptive sentence task where individuals are exposed to words embedded in sentences, with background noise, and multiple speakers and will be evaluated for in-home use by a larger group of users.